Pseudomembranous Aspergillus Tracheobronchitis: Case Report of a Rare Manifestation of Airway Invasive Aspergillosis

Aspergillus tracheobronchitis, an uncommon form of invasive pulmonary aspergillosis, is characterized by the development of a pseudomembrane, ulcers, or an obstruction that is predominantly confined to the tracheobronchial tree. Pseudomembranous Aspergillus tracheobronchitis is the most severe form of Aspergillus tracheobronchitis, and only a few cases have been reported in Korea. We report the characteristic chest CT findings in a patient diagnosed with pseudomembranous Aspergillus tracheobronchitis after bronchoscopy and successfully treated by proper antifungal treatment.

Merits of and Technical Tips for Supra-Mesenteric Aortic Cross Clamping

Supra-celiac aortic cross clamping is often utilized during aortic reconstruction for aneurysmal/occlusive disease involving the pararenal aorta. However, this may be accompanied a myriad of complications related to hemodynamic disturbances, cardiopulmonary compromise and hepatic ischemia. Supra-mesenteric aortic cross clamping may be an excellent option in selected patients with suitable anatomy to minimize or avoid these complications. Herein, the merits of and technical tips for supra-mesenteric aortic cross clamping are discussed.

Effect of Placenta-Derived Mesenchymal Stem Cells in a Dementia Rat Model via Microglial Mediation: a Comparison between Stem Cell Transplant Methods

PURPOSE: Loss of cholinergic neurons in the hippocampus is a hallmark of many dementias. Administration of stem cells as a therapeutic intervention for patients is under active investigation, but the optimal stem cell type and transplantation modality has not yet been established. In this study, we studied the therapeutic effects of human placenta-derived mesenchymal stem cells (pMSCs) in dementia rat model using either intracerebroventricular (ICV) or intravenous (IV) injections and analyzed their mechanisms of therapeutic action. MATERIALS AND METHODS: Dementia modeling was established by intraventricular injection of 192 IgG-saporin, which causes lesion of cholinergic neurons. Sixty-five male Sprague-Dawley rats were divided into five groups: control, lesion, lesion+ICV injection of pMSCs, lesion+IV injection of pMSCs, and lesion+donepezil. Rats were subjected to the Morris water maze and subsequent immunostaining analyses. RESULTS: Both ICV and IV pMSC administrations allowed significant cognitive recovery compared to the lesioned rats. Acetylcholinesterase activity was significantly rescued in the hippocampus of rats injected with pMSCs post-lesion. Choline acetyltransferase did not co-localize with pMSCs, showing that pMSCs did not directly differentiate into cholinergic cells. Number of microglial cells increased in lesioned rats and significantly decreased back to normal levels with pMSC injection. CONCLUSION: Our results suggest that ICV and IV injections of pMSCs facilitate the recovery of cholinergic neuronal populations and cognitive behavior. This recovery likely occurs through paracrine effects that resemble microglia function rather than direct differentiation of injected pMSCs into cholinergic neurons.

Evaluation of Validity and Reliability of Inertial Measurement Unit-Based Gait Analysis Systems

OBJECTIVE: To replace camera-based three-dimensional motion analyzers which are widely used to analyze body movements and gait but are also costly and require a large dedicated space, this study evaluates the validity and reliability of inertial measurement unit (IMU)-based systems by analyzing their spatio-temporal and kinematic measurement parameters. METHODS: The investigation was conducted in three separate hospitals with three healthy participants. IMUs were attached to the abdomen as well as the thigh, shank, and foot of both legs of each participant. Each participant then completed a 10-m gait course 10 times. During each gait cycle, the hips, knees, and ankle joints were observed from the sagittal, frontal, and transverse planes. The experiments were conducted with both a camerabased system and an IMU-based system. The measured gait analysis data were evaluated for validity and reliability using root mean square error (RMSE) and intraclass correlation coefficient (ICC) analyses. RESULTS: The differences between the RMSE values of the two systems determined through kinematic parameters ranged from a minimum of 1.83 to a maximum of 3.98 with a tolerance close to 1%. The results of this study also confirmed the reliability of the IMU-based system, and all of the variables showed a statistically high ICC. CONCLUSION: These results confirmed that IMU-based systems can reliably replace camera-based systems for clinical body motion and gait analyses.

Dual left anterior interventricular coronary artery with a rare course in a Korean / 대한해부학회지

Dual left anterior interventricular coronary artery (also called left anterior descending artery, hereafter referred as LAD) is a rare congenital coronary artery anomaly. Notably, type IV dual LAD has never been reported in Koreans. During a routine dissection, a new variant of type IV dual LAD was found in a 57-year-old Korean male cadaver, whose cause of death was unknown. One LAD originated from the right coronary artery, coursed through the anterior interventricular sulcus, but did not reach the apex cordis. The other LAD arose from the left coronary artery, never entered the anterior interventricular sulcus through its course, but reached the apex cordis, where it met the posterior interventricular branch of the right coronary artery. This is the first report on a new variant of type IV dual LAD in Koreans, which is of clinical importance during procedures containing the coronary artery.

MR Images of Infarction of Wandering Spleen Associated with Intestinal Non-rotation

Wandering spleen is a rare clinical condition caused by lax splenic suspensory ligaments. The laxity of ligaments causes torsion of splenic vascular pedicle. CT scan of a 7-year-old girl with abdominal pain showed a non-enhancing lobular mass in lower abdomen. Small bowel loops were located at the right-sided abdomen and colonic loops at the left-sided abdomen. MRI scan showed non-enhancing heterogeneous mass with twisted vascular pedicle. To our knowledge, only a few cases have been reported about wandering spleen diagnosed on MRI.

Perilesional Steatosis in Ectopic Pancreas Mimicking Exogastric Mass : A Case Report

We report an unusual case of ectopic pancreas that appeared on radiologic images as a lobulated, submucosal mass enclosed by fat component in the gastric lower body. Although, ectopic pancreas including fat component is extremely rare, in the setting of gastric submucosal mass with containing perilesional fat, these findings should be considered in ectopic pancreas as part of the differential diagnosis.

Robotic-Assisted Resection of Primary Rectal Cancer: An Analysis of Consecutive 185 Cases / 대한내시경복강경외과학회지

PURPOSE: Although some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of a robotic system, few studies have reported the use of robotic surgery for rectal cancer. This study analyzed prospectively the safety, morbidity, mortality and operation time of a robotic rectal resection for rectal cancer. METHODS: The data of 185 consecutive patients, who had undergone robotic rectal resection for rectal cancer at Korea University Aanam Hospital from July 2007 to April 2011, was analyzed prospectively. The postoperative outcomes and operative times were evaluated. RESULTS: Robotic rectal resection using a da Vinci surgical system was performed on 185 patients. There were 115 low anterior resections, 5 anterior resections, 1 Hartmann's operation, 10 ultra-low anterior resections, 43 intersphincteric resections and 11 abdominoperineal resections. The median hospital stay was 9 days. The overall morbidity rate was 33.4%. There was one conversion to open surgery. The mean passage of flatus was noted on postoperative day 2.0, diet was started on postoperative day 2.3 and the mean postoperative hospital stay was 13.7 days. The mean number of retrieved lymph nodes was 16. The total operation time decreased with increasing operator experience (306 min vs 285 min vs 268 min, p=0.009). CONCLUSION: A robotic rectal resection is feasible and safe for rectal cancer patients. The data showed an acceptable morbidity and mortality rate compared to the short term results of conventional laparoscopic and open surgery reported previously. Nevertheless, the oncologic and functional benefits of robotic colorectal surgery should be evaluated through a large scale study.

Edematous and painful external hemorrhoids following intersphincteric resection for low rectal cancer / 대한외과학회지

Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.

Prevalence and Characteristics of Major Vascular Diseases of Elderly Men in the Incheon Area

PURPOSE: As Korea is an aging society (WHO classification) and projected to be an aged society in 10 years, peripheral vascular diseases (PVD) in the elderly population has emerged as an important social and medical issue. But their prevalence was rarely reported in Korea. The purpose of this study is to define the prevalence of carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), and peripheral arterial occlusive disease (PAOD) of lower limb in the Incheon area. METHODS: Elderly men (> or =65 years) were referred randomly from the Incheon Federation of Korean Senior Citizens' Association (from Nov 2008 to Sep 2009) to Inha Univeristy Hospital, Incheon, Korea for a PVD screening program. The subjects were screened for CAS and AAA by duplex. CAS was defined as > or =50% internal CAS and AAA as > or =3 cm aortic diameter in minor axis. PAOD of lower limb was screened by measurement of ankle brachial index (ABI); ABI of < or =0.9 was considered abnormal. RESULTS: 1150 subjects were screened including 103 octogenarians (9.0%). Mean age was 72.3+/-0.2 years. Combined conditions were hypertension (54.3%), diabetes mellitus (25.2%), coronary artery disease (15.6%), dyslipidemia (18.9%), obesity (31.1%) and smoking history (71.7%). CAS was detected in 7.7% (89/1,150) subjects. Thirty-three (2.9%) were diagnosed with AAA. PAOD was detected in 50 subjects (4.4%). CONCLUSION: Prevalence of PVD in Korea is not lower compared to that of western countries, especially the USA and the UK. A nationwide program for timely detection and treatment for PVD should be developed.

Idiopathic Fibrosing Mediastinitis Causing Pulmonary Hypertension with Improvement by Steroid Treatment / 결핵및호흡기질환

Idiopathic fibrosing mediastinitis is, an uncommon cause of pulmonary hypertension this is characterized by excessive fibrosis of the mediastinum with an unknown etiology. Steroid therapy has been suggested for individuals with progressive symptoms, bu there is littlet data demonstrating the efficacy of such therapy are lacking. We present a case of pulmonary hypertension secondary to a compression of a main pulmonary artery by fibrosing mediastinitis which was confirmed by a biopsy with a thoracotomy. The chest CT scan and 2D echocardiography performed before and after a trial of steroid therapy demonstrated improvement after steroid therapy.

Prenatal Sonographic Findings in Chromosomal Abnormalities / 대한주산의학회잡지

No abstract available.

Recommended Protocol for Antenatal Corticosteroid / 대한주산의학회잡지

No abstract available.

Uterine Artery Doppler Velocimetry as a Screening Test in the Second Trimester Pregnancies / 대한산부인과학회잡지

We performed uterine artery Doppler velocimetry between 20~24 weeks of gestation to access the screening properties for predicting pregnancy-induced hypertension(PIH) or intrauterine growth retardation(IUGR) in general population. Total of 846 pregnant women were enrolled in this study. The abnormal uterine artery Doppler velocimetry result was found in 197 pregnancies during the Doppler measurement. The incidence of PIH and IUGR among study population was 3.3% and 4.3%, respectively. The incidences of PIH in normal and abnormal uterine artery Doppler velocimetry group were 2.2% and 7.1%, and those of IUGR were 3.9% and 5.6%, respectively. The incidence PIH and/or IUGR among abnormal Doppler group was 12.2%, which was higher than in normal group of 5.5%. This method had a sensitivity of 40.0%, a specificity of 80.0% and a positive predictive value of 12.2% for the prediction of PIH and/or IUGR. Although abnormal uterine artery Doppler velocimetry is associated with an increased risk of PIH and/or IUGR, the lowered positive predictability lead to apply the follow-up examination or standardization of Doppler ultrasonography.

The efficacy of combined OD650 test and shake test to predict fetal lung maturity / 대한산부인과학회잡지

No abstract available.

A study of antepartal fetal surveillance after 41 weeks of gestation / 대한주산의학회잡지

No abstract available.

A case of intrauterine fetal death from umbilical cord torsion / 대한산부인과학회잡지

No abstract available.

Clinical significance of early diastolic notch of uterine artery Doppler velocimetry in relation to placental location / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to investigate the relation between types of early diastolic notch and placental location and to evaluate the differences in perinatal outcomes. METHODS: We evaluated the Doppler waveform of the uterine artery in 149 pregnant women having an early diastolic notch after 26 weeks gestation, however we were unable to follow the obstetric outcomes in 20 women. Placental location was determined by transverse view of ultrasonography and classified as central and lateral placenta. The unilateral diastolic notches were divided into 3 groups depending on the placental location (ipsilateral: same side of the placenta, contralateral: opposite side of the placenta, and median: central placenta) RESULTS: In the bilateral notch group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one(n=60, mean=3.22 Vs 2.80, p=0.0067). Of the 89 unilateral notches observed, the S/D ratio of the uterine artery in patients having early diastolic notch was higher compared to those without early diastolic notch.(t-test, mean=2.74,1.92, p=0.0001) Patients with bilateral notches were associated with poor perinatal outcomes significantly more than the patients with unilateral notches(p=0.003). Among the unilateral groups (ipsilateral: n=10, median: n=21, contralateral: n=58), there was no significant difference in perinatal outcomes. CONCLUSION: The early diastolic notch can be observed on both or either sides of the uterine artery independent on placental location. More bilateral notches were associated with poor pregnancy outcomes than unilateral notches. The pregnancy outcomes tended to be similar in unilateral notch irrespective of placental location, but showed worse outcomes than the control group. Careful analysis of the uterine artery in nonplacental side is necessary because of the frequent appearance of early diastolic notch and higher vascular resistance.

Usefulness of total nitrate and nitrite in vaginal secretions as a predictor of premature delivery / 대한산부인과학회잡지

OBJECTIVE: This study is directed to determine whether the concentrations of nitrate and nitrite, metabolites of nitric oxide, in vaginal secretions could be used to predict a premature delivery. METHOD: A total of 60 pregnant women from March, 2000 to February, 2001 received continuous prenatal care and underwent delivery in our hospital was enrolled in the study. Gestational age was ranged between 20 and 37 weeks. Those patients were divided into four groups according to clinical parameters such as preterm labor, premature rupture of membranes and premature delivery. Specimens were obtained by thorough washing of vagina with 5 mL sterile physiologic sodium chloride solution for determination of nitric oxide metabolites. The total nitrate and nitrite concentration was determined by treatment with nitrate reductase followed by the Griess reaction. RESULTS: Subjects were divide into four groups (group I, no preterm labor and term delivery[n=19]; group II, preterm labor and term delivery[n=12]; group III, preterm labor and consequent premature delivery[n=6]; Group IV, preterm labor with premature rupture of membranes and consequent premature delivery[n=23]). Total nitrate and nitrite concentrations in group II-IV (62.2+/-50.3micromol/L in group II, 113.3+/-77.0micromol/L in group III, 101.9+/-72.4micromol/L in group IV) were significantly higher than the concentration in Group I (9.4+/-11.9micromol/L). From the receiver operating characteristic curve in the prediction of premature delivery, we set 27.6micromol/L as a cut-off value in this study. Sensitivity, specificity, positive predictive value, and negative predictive value were 71.9%, 78.6%, 79.3%, and 71.0%, respectively. CONCLUSION: Patients with premature delivery do have increased nitric oxide metabolites in vaginal secretions. These results suggest that nitric oxide may be involved in the initiation of cervical ripening and used as a predictor of premature delivery.